Greenhouse Gas Emissions Due to Unnecessary Antibiotic Prescriptions
for Respiratory Diagnoses
Jessica Tobin, BS
1
; Emily S. Spivak, MD, MHS
2
; Adam L. Hersh, MD, Phd
3
; Alexis Pearl Lee, MBA
4
Introduction
Results
• We obtained sample waste from an outpatient antibiotic prescription from the
University of Utah Outpatient Pharmacy including a paper bag, paper leaflet insert, and
plastic prescription bottle.
• We calculated emissions for the waste based on the weight of each item using the US
Environmental Protection Agency (EPA) GHGE factors (paper = 0.80, plastic = 0.02).
• We used national US estimates of unnecessary outpatient antibiotic prescriptions for
acute respiratory infections from 2014 and 2015 to calculate emissions.
5
• Total unnecessary antibiotic-associated waste emissions are calculated by multiplying
the total mass of each item by the appropriate emission factor depending on the waste
type (e.g., paper or plastic) and waste treatment method, which we assumed to be
landfilled.
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• We used the EPA’s Greenhouse Gas Equivalencies Calculator to convert emissions into
concrete greenhouse gas equivalents that providers and patients can understand.
Methods
Conclusio ns
1
University of Utah School of Medicine, Salt Lake City, Utah, USA
2
Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
3
Division of Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
4
Environmental and Social Sustainability, University of Utah Health, Salt Lake City, Utah, USA
• If global healthcare were a nation, it would rank as the planet's fifth-largest emitter of
greenhouse gas emissions (GHGE).
1
• Pharmaceuticals contribute 10-20% of US healthcare emissions, with a significant
portion in Scope 3 (indirect emissions).
2,3
• 30-50% of antibiotic use across US healthcare is unnecessary.
4
• Quantifying antibiotic-associated GHGE may be another tool for antibiotic stewardship
to influence prescribing and measure impact.
• We aimed to estimate the GHGE from waste associated with unnecessary antibiotic
prescriptions for acute respiratory infections in the United States.
References
141,778
244,986
76,692
463,456
66,458
114,837
35,949
217,244
-
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000
0-19 Years of Age 20-64 Years of Age ≥ 65 Years of Age Total
Weight (kg)
Paper Weight (kg) Plastic Weight (kg)
Figure 1: CDC estimate of 2014-2015 inappropriate antibiotic prescriptions for
acute respiratory infections.
Figure 3: AI generated image depicting 14,482,976
empty prescription bottles.
Figure 2: Weight of paper and plastic waste from 2014-2015 inappropriate
antibiotic prescriptions for acute respiratory infections.
• Waste emissions from national estimates of inappropriate respiratory antibiotic prescribing from 2014-2015 approaches the equivalent of driving
a gas-powered car around the equatorial Earth 40 times (961,610 miles driven by an average gasoline powered vehicle).
• We believe incorporating data on environmental waste and contributions to greenhouse gas emissions from unnecessary antibiotics can
strengthen antibiotic stewardship efforts and inform public health policy.
14,482,976
inappropriate antibiotic prescriptions
463,456 kg
of paper waste
217,244 kg
of plastic waste
375.109
MT CO2 e/ton
landfilled waste emissions
961,610
miles driven
(by an average gasoline powered vehicle)
1. Karliner J, Slotterback S, Boyd R, Ashby B, Steele K. Healthcare without harm. Climate-Smart Health Care Series Green Paper
Number One. 2019.
2. Eckelman MJ, Sherman J. Environmental Impacts of the U.S. Health Care System and Effects on Public Health. PLoS One. 2016 Jun
9;11(6):e0157014. doi: 10.1371/journal.pone.0157014. PMID: 27280706; PMCID: PMC4900601.
3. Eckelman MJ, Huang K, Lagasse R, Senay E, Dubrow R, Sherman JD. Health Care Pollution And Public Health Damage In The
United States: An Update. Health Aff (Millwood). 2020 Dec;39(12):2071-2079. doi: 10.1377/hlthaff.2020.01247. PMID: 33284703.
4. Hersh AL, King LM, Shapiro DJ, Hicks LA, Fleming-Dutra KE. Unnecessary Antibiotic Prescribing in US Ambulatory Care Settings,
2010-2015. Clin Infect Dis. 2021 Jan 23;72(1):133-137. doi: 10.1093/cid/ciaa667. PMID: 32484505; PMCID: PMC9377284.
5. Fleming-Dutra KE, Hersh AL, Shapiro DJ, Bartoces M, Enns EA, File TM Jr, Finkelstein JA, Gerber JS, Hyun DY, Linder JA, Lynfield R,
Margolis DJ, May LS, Merenstein D, Metlay JP, Newland JG, Piccirillo JF, Roberts RM, Sanchez GV, Suda KJ, Thomas A, Woo TM,
Zetts RM, Hicks LA. Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011. JAMA.
2016 May 3;315(17):1864-73. doi: 10.1001/jama.2016.4151. PMID: 27139059.
4,430,555
7,655,808
2,396,613
14,482,976
-
2,000,000
4,000,000
6,000,000
8,000,000
10,000,000
12,000,000
14,000,000
16,000,000
0-19 Years of Age 20-64 Years of Age ≥ 65 Years of Age Total
# of Prescriptions
Scopes of Healthcare Greenhouse Gas Emissions
